Conversion of vertical banded gastroplasty to stand-alone sleeve gastrectomy or biliopancreatic diversion with duodenal switch.

INTRODUCTION: Vertical banded gastroplasty (VBG) originated as a simplified bariatric operation to avoid malabsorption and provide lasting results due to a fixed stoma. Short-term results were excellent (50-70 % excess weight loss); however, patients often displayed maladaptive eating behaviors, and many failed to either achieve or sustain adequate long-term weight loss. Complications were also common including severe reflux and regurgitation, gastric outlet stenosis or stricture, gastrogastric fistula, and breakdown of the staple line.

METHODS: VBG conversions to Roux-en-Y gastric bypass or sleeve gastrectomy as well as endoscopic interventions such as band removal have been described but have very high complication rates. We describe conversion of VBG to biliopancreatic diversion with duodenal switch using endoscopic guidance to take down the VBG staple line and the mesh around the outlet.

RESULTS: This technique can also be used to safely convert a VBG to a stand-alone sleeve gastrectomy.

CONCLUSION: Complication rates have been low by this technique, and we encourage others to adopt this technique.